Enrollment Resolution Examiner I

The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas.

Responsibilities

Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review; Ensuring member and/or group documentation and transactional updates are completed to reconcile account discrepancies; Receives, reviews and updates discrepancies from internal departments and external customers relating to Membership subscriber/member/group files; Investigates, works, analyzes, tracks and monitors operational issues identified during financial balancing adjustment of funds; Participates in process and technology improvement efforts; Prepares regular and periodic reports for review and assurance of processing guidance; Initiates requests to other operational areas to resolve identified problems; Communicates with internal and external customers and makes recommendations for procedure changes; Maintains high regard for member privacy in accordance with corporate privacy policies; Be proficient in one line of business and able to process inventory from other lines of business as requested; Level II: Mentors and collaborates with team members, sharing best practices and reviewing work; Level II: Subject matter expert in one line of business; Level II: Supports implementation of new processes and procedures, including test cases, end user testing, and documentation; Level II: Represents Enrollment Resolution on corporate projects and cross functional work groups

Requirements

Conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position; Three (3) years' experience with financial data or Health Insurance Enrollment experience, or an associate degree in finance, accounting, or similar discipline; Capable of establishing constructive relationships with all levels of internal and external organization; Must be able to prioritize assignments and work accurately and independently within established time frames; Must be flexible and able to adjust to rapidly changing priorities; Must have solid communication skills, both verbal and written; Proven organizational, analytical, and time management skills; Computer proficiency, including experience in Microsoft Office Suite; Strong attention to detail and accuracy; Ability to complete work in a traditional office environment under fluorescent lighting; Ability to arrive on time at work and as scheduled; Ability to meet minimum performance metrics; Ability to orally communicate; Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time; Must be able to travel across the enterprise; Ability to work in a home office for continuous periods of time for business continuity

Nice to have

A minimum of five (5) years health insurance operations experience preferred (Level II); Ability to represent the department independently as a subject matter expert; In depth regulatory and Enrollment process knowledge in one line of business and working knowledge in an additional line of business (Level II); Proven ability to support and train peers (Level II)

Benefits

Participation in group health and/or dental insurance; Retirement plan; Wellness program; Paid time away from work; Paid holidays